>Year 2004, Issue 4
Justo JJM, Prado OE, Theurel VG, Rosa PR, Lozano EA
Ambulatory laparoscopic cholecystectomy. A good alternative
Cir Gen 2004; 26 (4)
PDF: 4. Kb.
Introduction: The current treatment for chronic lithiasic cholecystitis is laparoscopic cholecystectomy. The experience acquired by surgeons has allowed decreasing the time of hospital stay leading to propose it even as an ambulatory procedure. Since the first reports (1990), the specialized centers refer a yearly increment in the procedure reaching a success rate of 70 to 97% in the programmed ambulatory laparoscopic cholecystectomies (ALC).
Objective: To report the experience in a general hospital from the Ministry of Health with an ALC program in a 10-year period.
Setting: Second level health care hospital.
Patients and methods: Patients programmed for ALC that accepted the procedure, with ASA I, II, and III classification, with a car, not outsiders, and who were admitted at 7.00 hs, operated before 14.00 hs, and discharged maximally at 20.00 hs, with oral tolerance, and after anesthetic and surgical assessment. Analyzed variables were: age, gender, pre-operative diagnosis, associated diseases, surgical technique, surgical time, complications, causes for conversion, time of stay in recovery, oral tolerance, pain, re-admittances, causes for the failure of the ambulatory procedure, and post-operative complications.
Results: In 10 years, 1025 cholecystectomies were performed; 565 (55.12%) were laparoscopic, 405 (71.7%) were programmed to be ambulatory, and from these 75.5% were accomplished successfully; 17% were men and 83% were women, average age 40.5 years (14-85), surgical time 25 to 155 min; 302 corresponded to lithiasis and 4 to polyposis; recovery time averaged 6 hours (3-9). In 99 patients the discharge had to be delayed due to: conversion (26), pain (19), vomiting (18), administrative cause (17), outsider (15), and patient’s preference (4).
Conclusion: The most important factor for failure was conversion. Physical condition, obesity, associated diseases or duration of surgery had no impact on the results. An ALC program is feasible and safe to implement in a general hospital caring for an open population.
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>Year 2004, Issue 4